Online and Text Therapy

What is it like talking to a Sex Therapist online?

Rhiannon No Comments

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Here in Central Texas, we get pretty bad thunderstorms… and sometimes the power goes out during session.  I always tell my clients I will try to reconnect because so far (knock on wood) the only power that I have lost was because an electrician was working on the house and brief interruptions due to lightening and severe weather.  We always have the phone for back up as well.

This photo was taken by a client the moment the power got knocked out and before we got kicked off.  I was frozen on her computer screen in this eerily lit image.  We both thought it was cool and she sent it to me.  So, because it is a cool image and shows what I look like on the system I use, I thought I’d share it with my readers.

Sex Coaching, Sex Counseling, Sex Therapy

Rhiannon No Comments

There are so many words that people type into search engines when they are looking for some extra help in their sex lives (sex coaching, sex counseling, sex therapy), and sometimes when I am looking through my website data, I am surprised at what people search for, and how many different spellings of sex therapy people can create (sex therpy, sex thrapy, sexthreapy, sex theropy, sex terapy, sex thearapy, sex thearpy, sex therepy, and on and on).  People search for services like sex counseling, sex coaching, sex therapy, sex advice, and sex education and search for a professional like a sex counselor, sex therapist, sex educator, and sex coach.

I also get a lot of questions what the difference is between a sexual therapist, a sexual counselor, and a sexual coach. Then some of the questions go even further on if I am a surrogate partner therapist or provide any hands-on instruction/sex services.  To be clear, I am not a surrogate partner or a sex worker.  Most people realize they have made the wrong call pretty quick but if they stay on the line long enough, they usually realize that they could use my services!

As a Licensed Marriage and Family Therapist and Certified Sex Therapist, I often get asked if I do sex coaching and what the difference between sex coaching, sex counseling and sex therapy are.  These are important questions because it will matter how you proceed in seeking out the services you are looking for and what professionals you work with.  I will start by addressing what I do.

I am a Licensed Marriage and Family Therapist in the states of Maine, Massachusetts, New York, New Hampshire, and Texas, and an American Association for Sexuality Educators, Counselors, and Therapists (AASECT) Certified Sex Therapist, I provide sex counseling and sex therapy to individuals and relationships.

Sex Counseling vs. Sex Therapy
While counseling and therapy are used interchangeably in the mental health world, in the sexual health world, the certifying body for sexual therapy, sexual counseling, and sexual education, the American Association for Sexuality Educators, Counselors, and Therapists (AASECT) delineates a sex therapist from a sex counselor.

AASECT Certified Sex Therapists are licensed mental health professionals, trained to provide in-depth psychotherapy, who have specialized in treating clients with sexual issues and concerns. In the absence of available licensure, they are certified, registered, or clinical members of a national psychotherapy organization. Sex therapists work with simple sexual concerns also, but in addition, where appropriate, are prepared to provide comprehensive and intensive psychotherapy over an extended period of time in more complex cases.

AASECT Certified Sexuality Counselors represent a variety of professions, ranging from medicine to the clergy. Examples of sexuality counselors are Planned Parenthood counselors, nurses and other health professionals, school counselors, and clinical pastoral care and counseling providers. Counselors assist the client to realistically resolve concerns through the introduction of problem solving techniques of communication as well as providing accurate information and relevant suggestions of specific exercises and techniques in sexual expression. Sexuality counseling is generally short term and client centered, focusing on the immediate concern or problem.”  www.AASECT.org

A sex therapist does sex counseling and sex therapy.  A sex counselor is more limited in their scope.  For more information on the scope of an AASECT Certified Sexuality Counselor and Therapist, click here.

So when you are searching for general counseling or general therapy, you would essential be searching for the same thing, but when it is sex specific, you may be looking at something different.  An interesting point, however, is that the word counseling is often more searched on the internet than therapy, which can also provide some insight that more people refer to”counseling” than “therapy” (and might make the language even a little bit more confusing around what direction to take), but as an AASECT Certified Sex Therapist, I provide sex counseling AND sex therapy.

It can be a little confusing when discussing the different professions practicing sex therapy.  There are social workers, mental health counselors, pastoral counselors, art therapists, psychologists, etc.  Psychology Today, a great online directory for mental health therapists, has a wonderful link to the differences between the professions here.

It is important that anyone seeking out sexual therapy or sexual counseling is an educated consumer and knows the credentials of their therapist or counselor.  Don’t be afraid to ask your counselor for their credentials, what fields they specialize in, and their training and expertise.  You wouldn’t go to a orthopedic surgeon for a skin rash, so don’t go to a sex therapist that isn’t trained in your presenting problem (but keep in mind, what you define your presenting problem may not actually be the problem at all).

And there is something to be said about this fact: that there are some excellent sex therapists and sex counselors out there that are not “certified”.  However, there are way MORE therapists out there that say they “do” sex therapy or sex counseling, but don’t have the adequate training, knowledge, and experience to work with your sexual issues.  As mentioned above, be an educated consumer and do your homework about the qualifications, experience, knowledge, and training of your sex therapist or sex counselor.

What is sex coaching?
Sex coaching gets a little more complicated as there isn’t a lot of regulation around what the term “sex coach” is.  A dear colleague of mine feels very passionate about sex coaching and her, along with her competent team of experts, have created a training program for Sex Coaches.  Since there isn’t a lot of regulation around sex coaches, although last time that I checked with her, she was trying to get AASECT to recognize coaches as a certification level, it may be hard to determine who is actually a qualified sex coach and who isn’t.

I am a sex therapist but do sex coaching.  Sex coaching is about providing educational and instructional methods for sex and intimacy.  However, since I am also a sex therapist and counselor, I will always operate with that ethical code in mind regardless of the service I offer.  That means that where some sex coaches who aren’t regulated by a licensing or certification board may engage in some interventions or recommendations, I would not if it violates my code of ethics or my professional boundaries.  Coaching often aims to stay in the here and now and the future, and doesn’t specifically focus on any past or current traumas or intensive work.  In general, I find that most people benefit at first from counseling and therapy and once issues that are contributing to/creating the sexual issues are addressed, if their sexual issue remains, then a coaching approach may be the next step.  That transition can be easily made with my clients and it isn’t necessary to delineate the approach within the work since even if we are working with coaching techniques, my professional identity and integrity is always as a sex therapist.

I believe the word “coaching” attracts people because it implies that they will just be told what needs to be done and as long as they follow it their lives will be better.  Sexual therapy or sexual counseling seems like hard work or very “deep” so people are attracted to coaching because it is more about behavioral change.  As a therapist and counselor, I caution those that look to sex coaching and not to sex therapy or sex counseling.  A good sex therapist will help construct new solutions with their clients, not direct or provide advice based on their own experiences to a client.  A good sex therapist will leave their own experiences at the door (unless therapeutically relevant) and understand that their clients experiences are independent of their own.  Also, sometimes a course of sex therapy or sex counseling can greatly improve the situation or completely resolve the situation, whereas coaching may not have because it did not attend to the causal/maintenance factors that required therapy.

While I am not trying to fault coaching, after all, help comes in many different forms and if it works for you, then keep doing it.  I am just trying to caution those clients who seek out sex coaching when they really need sex counseling or sex therapy.

If you feel like you are unsure of which route to take, contact me at the information below  to talk more to a sex therapist about your goals and which route would be best for you.

Resources and Apps

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Resources and Apps Related to Sex Therapy, BDSM, and Therapy

I recently facilitated a workshop entitled “50 Shades of Gray Areas When Working with Sex and Sexuality”.  I wanted to share just a few resources from my personal library as well as some resources that I know about.

A note about the resources.  Some of these resources I have used personally and with clients and some of these resources I just know about.  Please use your discretion on whether they are appropriate for your clients.  Also, be aware that the use of some of these apps may have some HIPAA considerations so do your research if there is a concern.   Some are free, some cost if you want to use them more than an introductory period, and some cost just to use.   When making any recommendation, it is always encouraged to read, view, and/or try out the resource before recommending.

Apps for Therapy
These can be used for any type of therapeutic goal. 
Hay House Vision Board App – helps create digital vision boards using photos and internet images
Moody Me Mood Diary and Tracker – tracks mood and has a journal function
Coggle– a program on your computer for mind mapping

Apps for Meditation
The apps are great for working with busy brains around life and sex.  
Calm
Headspace

List and Document Apps
These can be used for therapeutic tasks/journalling amongst other things. 
Trello
Evernote

Tracking Apps
Tracking is a WONDERFUL way to gain awareness to the actual problem the clients are facing in a realistic and accountable way.  A great technique that often can show the client something they didn’t see before.  
Track and Share– can track ANYTHING and really helps with tracking sexual issues, desire, etc.
Counted– a great app for counting anything

BDSM Resources
Brame, G., & Brame, W. (1993). Different loving: An exploration of the world of sexual dominance and submission. New York: Villard Books.

Brame, G. (2014). Come hither a commonsense guide to kinky sex. New York: Touchstone.
Fowler, F. (n.d.). Fifty shades of chicken: A parody in a cookbook.
James, E. (n.d.). Fifty shades of Grey.
Other Resources (just a couple from the presentation)
Hertlein, K. (2009). Systemic sex therapy (Second ed.).
Hertlein, K., & Weeks, G. (2009). A clinician’s guide to systemic sex therapy. New York: Routledge.
Leiblum, S. (2007). Sexuality and Culture. In Principles and practice of sex therapy (4th ed.) New York: Guilford Press
Schnarch, D. (1991). Constructing the sexual crucible: An integration of sexual and marital therapy. New York: Norton.
For more information regarding the above resources or my practice, please feel free to contact me at rhiannon[at]sextherapy-online.com or 603.770.5099 or by using the form below.  I am available for professional consultations, clinical supervision, and mentoring.

Is Online Sex Therapy Right for Me?

Rhiannon No Comments

Is online sex therapy right for you?  Clients are sometimes hesitant to start sex therapy online, preferring to see me in person.  But that quickly changes when they realize how many benefits there are to seeing me online.

In fact, many clients who have the option to see me in person, whether at my Austin, TX location or my Northeast locations, often elect not to because they are thrilled with the convenience that phone or online sex therapy offers them.

If you want to know if online sex therapy, online sex addiction therapy and phone sex therapy might be a good choice for you, ask yourself these questions:

1. Do I like traffic and cramming into little parking spaces?
If no, online sex therapy might save on gas and mileage and prevent wear and tear on my car.

2. Do I feel really comfortable talking to a professional about sex when they are sitting three-four feet away from me?
Phone or online sex therapy might be the right fit and you might feel more comfortable talking to someone over the phone or online if you don’t feel comfortable talking in person. Also, text therapy is always an option as well if it is really difficult for you to talk about your concerns.

3. Do I have an infinite amount of time to spend making appointments, driving to appointments, getting ready for appointments, missing work for appointments, and getting home late after an appointment?  time photo
Your time is precious and phone or online sex therapy can fit perfectly into your schedule on your lunch hour or after work while you are waiting for rush hour to calm.

4. Do I want everyone to see me walk in and out of a sex therapists office? people sitting photo
If you value your privacy, phone or online sex therapy will provide you with the privacy that high profile folks like yourself need.

 

 

5. Do I like going to a therapist in my area that has no expertise in the concerns I have with my life because I can’t find a specialist?
You deserve to have the best therapist available to you.  Online sex therapy allows you to access a qualified sex therapist no matter where you live.

Do you have more questions?  Feel free to fill out the form below and I’ll get back to you!

Ten Reasons Why Online Sex Therapy Works (Maybe Better Than In-Person Sex Therapy?)

Rhiannon No Comments

I get asked this question all the time: from professionals, from prospective clients, from strangers on the street (well not really, but sometimes!).  And like most blogs I write, the answer isn’t simple OR short-winded!

I became interested in online therapy after I moved my practice from the metropolitan area of New York to rural New Hampshire. After I did a six month follow-up phone call to all of the clients that I had referred to other therapists in New York when I left, I realized that many of my clients didn’t pursue the referrals I had given them, didn’t connect with the therapists that I had referred them to as well as they connected to me, and weren’t continuing therapy because of it. Since this was years ago and there weren’t a lot of rules or regulations surrounding online therapy or being an online therapist, I began seeing a few clients online and over the phone.

Fast forward three years and as I shifted my focus from working with couples and families to only working as a sex therapist with individuals and couples.  I kept encountering questions and raised eyebrows about my work as an online sex therapist (I also encountered a lot of enthusiasm and support along the way as well!).  I’ve compiled these into my Ten Reasons Why Online Sex Therapy Works (Maybe Better Than In-Person Sex Therapy?).

1. Accesibility
I would often get calls from people all over the states that I was working in looking for sex therapy.  There aren’t a lot of sex therapists available and in many rural areas there aren’t even therapists available.  More and more people kept calling me looking for sex therapy in their area and I had no where to send them. And as I expanded my licensure to the states of Maine, Massachusetts, and Texas, I realized that there were more and more people that needed my services in those states.

2. Privacy
Living and working in a small rural New Hampshire town (my office was literally across the street from my condo) I found that it was very easy to get to know the community relatively quickly. I started my practice in metropolitan New York and I think one I time I ran into a client out and about. But in the town I was practicing in and the surrounding areas, it was impossible not to have that overlap. My clients at times seemed more comfortable with it than me; however, there were several times where clients or prospective clients would call and come in and realize that there was a common element and decided to not pursue therapy.  The more and more I was working in sex therapy, the more and more I was realizing that people didn’t always feel all that comfortable talking to someone that lived in their community about their sexual life.

3.  The Dreaded Waiting Area

Most therapists put a lot of energy and time into designing and decorating our waiting areas. We want the areas to be comfortable, clean, welcoming, and relaxing. Depending on your location and your facility, you may or may not be able to achieve that.  As my sex therapy practice became more and more popular, I realized that the waiting room was a source of intimidation for new clients.  Especially since the last office I had was across from a yoga studio and a ballet studio and had a common shared waiting space and my clients often would come to session during busy class times where parents were also waiting for their children in those classes or yogis were waiting for the next class. This made things very hard on my practice and my clients. It’s very difficult to maintain confidentiality in a waiting space, especially a shared waiting space. And I began to realize that many clients would prefer to not have to sit in a waiting room (or even walk through the doors to a building that housed a sex therapist) to go to sex therapy.

4. Let’s Talk About Sex
Fact: It’s not always that easy to talk about sex. Fact: It’s not always that easy to talk about sex in front of someone that you’re just meeting for the first time. I do think some of my clients find it easier to talk to me about sex over the phone or over the computer. The fact of the matter is a lot of folks don’t have good communication skills, and a lot of folks don’t have good communication skills around sex. Being able to provide online sex therapy has opened up a lot of opportunities for folks who struggle with communicating about sex. I realize that I’d rather do therapy with the whole picture from a distance than therapy with just a portion of the picture in-person. And if this sounds like an interesting and novel idea, check out my blog on Text Therapy.  Now if communication about sex is one of the clients’ issues and one of the clients’ goals, we may eventually move toward meeting in person for therapy as a therapeutic goal. For that reason I periodically see my clients in person if it’s possible a few times a year. I really try to meet all my clients in person at least once.

5. Convenience
Another fact: People are busy! Especially people with sexual issues. I find that a common element with most people with sexual issues, and I say most, is that they’re pretty busy. And oftentimes by the time they get to me there in other therapeutic programs, other meetings, other groups, and often don’t really have time for another appointment that includes travel, traffic, parking, etc. Being an online sex therapist, and doing sex therapy online, allows my clients to conveniently schedule appointments at times that work for them: their lunch hour, after the kids go to bed, in their parked car before they go home from work. Any of these arrangements have proved to be very convenient for my clients. Especially in doing online sex therapy in metropolitan New York and New York City.  Those clients can commute up to three hours ONE WAY to get into work.  Tell me when they might have time to go to sex therapy? In general my clients find online therapy easier and more convenient than in-person therapy.  Because of that factor, my clients are often more committed to the therapeutic process and are less likely to stop therapy due to inconvenience or not having time.

6. A Window Into their REAL World
It’s amazing what seeing my clients in their natural environment can tell me about their situation. It’s a luxury we don’t get when your clients come to your office. But seeing the types of distractions that the clients face in their environment can really give a therapist insight into the impact that their home life has on their sexual life. For example, if your kids or dogs are constantly interrupting your therapy session, what do you think that’s doing for your sex life? Interesting point right?

7. Meet Them Where They Are At
One of the services that SexTherapy-Online offers is the online treatment of sex addiction and sexual compulsivity.  Online therapy for sex addiction is just one modality of treatment for sex addiction. There are many other treatment options for sex addiction (see my previous blog post here for more information) such as twelve-step programs, inpatient residential treatment programs, and outpatient treatment programs that are all very effective at treating sex addiction. What makes online sex addiction therapy interesting and different than those other modalities is that online sex addiction treatment takes place in the environment that many sex addictions start in, live in, and are maintained in: the Internet. It makes sense that one would treat the problem where the problem exists. If the problem exists with inappropriate behavior on the Internet, which many sex addictions have this component, it would make sense to also treat it using the Internet. One hour a week in one’s office is not a realistic environment. One hour a week on the Internet is a lot closer to home for someone who is struggling with sexual compulsivity that involves the use of the internet.

8. Increasing Therapeutic Opportunities for All
There are many times in a therapist’s career when clients will present with unique situations that will make it challenging to provide the best treatment possible. Online therapy, and specifically online sex therapy, provides therapeutic opportunity for clients that may be underserved by our traditional therapeutic models. For example, a transgender client in the process of transitioning who is very concerned and sensitive about their transition process may feel more comfortable staying at home and doing therapy from the comfort of their own home. For example, a client with a chronic stutter who has difficulty speaking and forming ideas in the verbal domain may feel more comfortable using text therapy as a modality with their therapist. For example, a client who has significant health concerns and has trouble leaving the home due to those concerns may find online therapy a more accessible model for receiving mental and behavioral health services. For example, the client who lives in an area with inconsistent weather patterns or perhaps difficult transportation options may find online therapy are more accessible option for receiving services. For example, the high-profile politician who is struggling with a sexual issue but is too fearful of being seen going to a therapists office can access online sex therapy services from the privacy of home.  Those clients that I just mentioned may have never dreamed of having access to a therapist, let alone a sex therapist. Imagine all the people that sat in silence, suffering with sexual issues that could be helped using online therapy.

9. Environmental Impact of Distance Based Therapy
Now is the time that my inner environmentalist comes out and discusses how time, energy, and resources are all conserved when conducting therapy at a distance. Instead of maintaining two offices, I maintain one. Instead of traveling to my office or my clients traveling to my office, we all stay in existing environments, saving on time, resources, and energy.  Therapy should be something that is accessible and convenient. We can each do our parts and by putting my entire practice online I no longer have any paper documents, I do not maintain two office spaces with two sets of utility bills, and I conserve my energy usage significantly.  Having a distance-based practice is my way of contributing to cutting down on the use of resources for both my clients and myself.

10. A New Technological Model of Therapy
An important concept that is a little bit hard to grasp for a traditional, in-person therapist (and a little underdeveloped in the field) is the fact that online therapy is not just a way to deliver therapy at a distance but rather a model of therapy within and of itself. Online therapy has essentially its own unique characteristics as a model of therapy such as position of the therapist, specific interventions related to online therapy, processes of joining and building rapport, and different components of assessment and intervention.  It is a therapeutic model AND modality.  Online Sex Therapy is effective and it works!

 

For more information, feel free to contact Rhiannon at 603.770.5099 or rhiannon@SexTherapy-Online.com.

Practicing in Maine, Massachusetts, New Hampshire, New York, and Texas.

“Text Therapy On the Rise”- Do these reports help or hurt our field?

Rhiannon No Comments

There is no such thing as bad publicity, right?  (I did a little research into that phrase and apparently it is often associated with Phineas T. Barnum, the 19th century American circus owner… interesting source… has anyone read “Water for Elephants)?

I like the 100 year old version published in the Atlanta Constitution that states”All publicity is good if it is intelligent”.”  Indeed, I agree with the latter phrase: publicity is good ONLY if it is intelligent, and to be honest, I question whether this news broadcast sounds very intelligent at all.  (No offense to Dr. Rushkin, in fact, I think her work is great and I would love to have lunch with her and discuss our mutual interests, but I have some comments on a recent broadcast on text therapy).

Boston News, Weather, Sports | FOX 25 | MyFoxBoston
 

Dr. Karen Ruskin, labeled as a “psychotherapist” but after doing a little research, I found out that she holds a PsyD AND is a Licensed Marriage and Family Therapist (so she is WELL qualified to discuss this topic- this is not an attack piece at all!), discusses how times have changed, and indeed they have! How many times a day do you pick up the phone to call someone to talk vs. how many times a day do you text someone to talk? Chances are if you have a Smartphone, you text way more than call. In fact, a 2012 Time Article (found here) states that even amongst people age 65+, texting still wins over calling (but not by much!).

I’ll paraphrase her and state while she said that it is of “therapeutic value” to text with your therapist, it is “NOT, I REPEAT, ABSOLUTELY NOT INSTEAD OF THERAPY”.  So here is where I feel like this publicity is bad publicity: this statement implies that text therapy  is considered, NOT therapy, when depending on the content of the conversation, it could, in fact, BE therapy!

I also think she does a poor job at portraying text therapy (and maybe it’s because I have watched the clip a million times, but it really does seem kind of condescending and mocking of the online distance therapy field… but I am not taking it personally).   She also speaks so authoritatively I worry that folks watching this broadcast would actually think that what she is talking about is actually WHAT text therapy IS (and as an online sex therapist that uses text therapy, her portrayal is not AT ALL how I practice text therapy).

Text therapy isn’t about reading something and having it feel “energizing”.  The text therapy I do is real therapy, just instead of TALKING we write down our conversation.  It is a slower pace, with immense therapeutic value.  How many times have you written something down, thought about it, and rewritten it to have it actually mean what you want it to mean? Imagine if you could do that in therapy?  Imagine if you had the opportunity to write, and rewrite your thoughts, feelings, impressions, opinions, etc. before presenting them to another person (like a therapist)?  Can you see how that could be useful in therapy?

In the therapeutic community, we often use written assignments and journalling as therapeutic interventions because we believe that accessing the part of the brain responsible for written language offers an additional opportunity for healing and growth so it would make sense to utilize that in a therapeutic realm as well.  (There is so much research and literature on this topic!) So if we believe that writing is a valuable form of therapeutic communication, why wouldn’t we do therapy in writing???

Dr. Ruskin also mentions the relationship between a therapist and a client, and insinuates that over text the relationship is somehow not as connected, that y0u can’t clarify misunderstandings, and you can’t see body language and facial expressions.  Now I agree with her, in text, you do “lose” (I would use a different term) body language, facial expressions, and other physical factors that you have may have in a traditional in person practice, however, you gain some things you don’t get in the verbal talk therapy realm AND to be completely honest, text therapy is closer to the real life communication that most people are having in their regular lives anyway.  Why wouldn’t we deliver therapy in text format if most of our conversations with people close to us are through text-based modes of communication (Facebook, Twitter, Texting, Email, Etc.)? It would be silly to only offer therapy in one dimension (verbal) when so much communication is going on in other dimensions!

Dr. Rushkin states “so as times have changed with regards to what we even define as a relationship” and in response I want to state that it is a natural evolution of the field that times would have changed in what we define as a therapeutic relationship.  Makes sense? (If it doesn’t, let me know as I want to make sure my thoughts and ideas are clearly being expressed in written form [see how easy it is to clear up a misunderstanding through text?])

I also feel like Dr. Rushkin and the reporter misrepresent text therapy as if it is just this when-I-feel-like-it, on-demand therapy, when in fact, that is not how I do text therapy AT ALL.  My text sessions have regular scheduled times, and operate like other traditional sessions.  I am very clear with my clients about appropriate communication boundaries and my clients respect that their therapeutic time is their therapeutic time and if they have something to say to me in between sessions they can either send me an email, call me, or schedule an additional appointment.  Done.  I am not sure what type of text therapy they are referencing, but that is not how I do my text therapy at all!

In answer to Dr. Rushkin’s belief that text therapy is better than if someone did nothing, I feel like that minimizes the value of this modality.  This isn’t one step above suffering, this is a TRUE and AUTHENTIC therapeutic modality, with its own interventions, position of the therapist, belief of problem, etc.  Once I put away my feelings about how this statement is a little offensive, I bring myself back to the point that text therapy makes therapy accessible to those who may not have had access to therapy without it.

Text therapy might not be for everyone however, just as psychoanalysis or other types of therapy aren’t for everyone either.  But text therapy for a chronic stutterer seems like a very good option.  Text therapy for someone who feels too embarrassed to talk about their sexual issues to another person but feels comfortable communicating over text also seems like a good fit.  Text therapy for someone who lives in a very rural area that has limited internet access but just enough to be able to communicate via online text- also a win.  The list goes on and on.  And text therapy for someone who just feels more comfortable texting than talking, that sounds just fine too.

Text therapy isn’t something that is going to dilute modern therapy, it’s something that can accentuate it!  We don’t have to fear it replacing “traditional” therapy, but rather it’s the new kid on the block.  We should welcome text therapy to the neighborhood!